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General NPI Number Information
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NPI Number | 1245491430
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Entity Type | Organization
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Legal Business Name | BURNHAM & BURNHAM M.D.P.C.
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Dates
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Enumeration Date | 06/19/2008
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Last Update Date | 10/14/2008
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Provider Practice Location Address
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Address Line | 1918 S LEMAY AVE SUITE A
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City | FORT COLLINS
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State | CO
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Zip | 80525-1294
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Country | US
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Telephone | 970-494-4531
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Fax | 970-494-4538
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Provider Business Mailing Address
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Address Line | 1918 S LEMAY AVE SUITE A
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City | FORT COLLINS
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State | CO
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Zip | 80525-1294
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Country | US
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Telephone | 970-494-4531
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Fax | 970-494-4538
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Authorized Official
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Title or Position | FAMILY PRACTICIONER
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Name | LINDA A BURNHAM
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Credential | MD
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Telephone | 970-494-4531
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 21180
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License Number State | CO
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